2Newborn babies struggle a lot when they are adapting to the new environment. The first hour of birth is the most crucial period and how well a baby is cared during this time will determine the future health and wellbeing. Health professionals play an important ole during this adaptation phase. Poor care prevents complications and ensures good survival.
3HEALTHY NEWBORNA healthy baby born at term should weighs more than 2500 grams, cries immediately following birth establishes independent rhythmic respiration & quickly adapts to the changed environment.
4CARE OF NEWBORN AT BIRTH Call out the time of birthReceive the baby onto a warm, clean and dry towel and place on mother’s chest
5Contd.. Clamp and cut the umbilical cord Immediately dry the baby with a warm clean towel or piece of cloth
6Contd.. Assess the baby’s breathing while drying Wipe both the eyes with sterile gauzeLeave the baby between the mother’s breasts to start skin-to-skin carePlace an identity label on the baby
7Contd..Cover the baby’s head with a cap; cover the mother and baby with a warm clothEncourage mother to initiate exclusive breastfeeding
8IMMEDIATE BASIC CARE Establishment of open airway & circulation Maintenance of temperatureIdentification of newbornVitamin K injectionInitiation of breastfeeding.
9ESTABLISHMENT OF OPEN AIRWAY (Majority of babies cry at birth & take spontaneous Respiration)When the head is delivered birth attendant immediately suction the secretions, wipe mucus from face and mouth and nose.
10Suction the mouth and nose by using bulb syringe Keep head slightly lower than the bodyPosition the Baby on their backs or tilted to the side, but not on their stomachs.
11APGAR SCORING TOTAL SCORE = 10 No depression: 7-10 CRITERIA12RespirationAbsentSlow, irregularGood, cryingHeart rateSlow (Below 100)More than 100Muscle toneFlaccidSome flexion of extremitiesActive body movementsReflex responseNo responseGrimaceCrySkin colorBlue, paleBody pink, extremities blueCompletely pinkTOTAL SCORE = 10No depression: 7-10Mild depression: 4-6Severe depression: 0-3
12VITAMIN KVitamin K Prevent neonatal hemorrhage during first few days of life before infant is able to produce Vitamin KTerm infants (1mg) - IMPreterm infants (0.5mg) – IM
13INITIATION OF BREASTFEEDING Babies can be breast-fed as soon as the airway is cleared and they are breathing normally.
14DAILY ROUTINE CARE OF NEONATES ThermoregulationBreastfeedingSkin care & baby bathCare of umbilical cordCare of the eyes
15Clothing of the babyGeneral careObservationTaking anthropometric measurementImmunizationFollow up & advice
161. THERMOREGULATION Mechanisms of heat loss Convection Evaporation RadiationConduction
17WARM CHAIN Keep the baby clothed and wrapped with the head covered Minimize bathing especially in cool weather or for small babiesKeep the baby close to the motherUse kangaroo care for stable LBW babies and for re-warming stable big babiesShow the mother how to avoid hypothermia, how to recognize it, and how to re-warm a cold baby. The mother should aim to ensure that the baby's feet are warm to touch.
25Temperature recording Axillary temperatureRectal temperatureSkin temperature
262. BREAST FEEDINGThe baby should be put to the mother’s breast within half an hour of birth or as soon as possible the mother has recovered from the exertion of labour.
273. SKIN CARE & BABY BATH: The skin should be cleaned off blood, mucus & meconium by gentle wiping before he/she is presented to the mother.Baby bath can be given at the hospital or home by using warm water in a warm room gently & quickly.
284. CARE OF THE UMBILICAL CORD Keep the cord stump clean and dry.Topical application of antiseptics is usually not necessary unless the baby is living in a highly contaminated area.
295. CARE OF THE EYES Eyes should be clean at birth & once in every day using sterile cotton swabs soaked in sterile water or normal saline. Separate swabs for each eye.
306. CLOTHING OF THE BABY The baby should be dressed with loose, soft & cotton cloths. The frock should be open on the front or back for easy wearing.Large button, synthetic frock and plastic or nylon napkin should be avoided.
317. GENERAL CARERooming –ingentle approachAseptic techniquesensory stimulationtender& loving care
328. OBSERVATION The baby should be kept in continuous observation twice daily for detection of any abnormalities or danger signs
33DANGER SIGNS 1. Not feeding well 2. Less active than before 3. Fast breathing (more than 60 breaths per minute)4. Moderate or severe chest in-drawing5. Grunting / moaning6. Convulsions
34Contd.. 7. Floppy or stiff 8. Temperature >37.50C or <35.50C 9. Umbilicus draining pus or umbilical redness extending to skin.10. More than 10 skin pustules or bullae, or swelling, redness, hardness of skin11. Bleeding from stump or cut
3610. IMMUNIZATIONNewborn should be immunized with BCG vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’ vaccine can be administered at birth as first dose & other two doses in one month & 6 months of age.
3711. Follow up & advice PREPARATION FOR DISCHARGE Feeding well - suckling effectively 8 times in 24 hours, day and nightNo danger signsNo need for any medication except vitaminsMother confident of taking care of the babyEach infant should be followed up, at least once every month for first 3 months & subsequently 3 month interval till one year of age.
38PREVENTION OF INFECTIONS CLEAN CHAINBREAST FEEDINGIMMUNIZATIONCARE OF SKIN, EYE AND CORD
39‘Clean chain’ 1. Clean delivery (WHO five cleans): – Clean attendant's hands (washed with soap)– Clean delivery surface– Clean cord- cutting instrument (i.e. razor, blade)– Clean string to tie cord– Clean cloth to wrap baby and mother
402. After delivery:– All caregivers should wash hands before handling the baby– Feed only breast milk– Keep the cord clean and dry; do not apply anything– Use a clean cloth as a diaper/napkin– Wash your hands after changing diaper/napkin
41NURSING DIAGNOSESIneffective airway clearanceIneffective thermoregulationRisk for injuryRisk for infection